A prospective study of intensive in-patient treatment for obsessive-compulsive disorder

• Published in: Psychiatry research Vol. 291; p. 113303
• Main Authors: Nanjundaswamy, Madhuri H., Arumugham, Shyam Sundar, Narayanaswamy, Janardhanan C., Reddy, Y.C. Janardhan
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-09-2020
• Subjects: Adolescent; Adult; Aftercare - methods; Aftercare - trends; Cognitive Behavioral Therapy - methods; Cognitive Behavioral Therapy - trends; Cognitive-behaviour therapy; Combined Modality Therapy - methods; Combined Modality Therapy - trends; Female; Humans; Inpatients - psychology; Male; Middle Aged; Obsessive-compulsive disorder; Obsessive-Compulsive Disorder - diagnosis; Obsessive-Compulsive Disorder - psychology; Obsessive-Compulsive Disorder - therapy; Patient Discharge - trends; Prospective Studies; Psychiatric Status Rating Scales; Residential treatment; Treatment Outcome; Treatment resistant, in-patient treatment; Young Adult; Cognitive-behaviour therapy; Obsessive-compulsive disorder; Residential treatment; Treatment resistant, in-patient treatment
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2020.113303

•The current study prospectively evaluated the outcome and predictors of outcome following in-patient therapy for OCD.•Intensive in-patient treatment, incorparating cognitive-behaviour therapy and medication management, is effective in a subset of severely ill obsessive-compulsive disorder patients.•Poorer insight is associated with non-response to in-patient treatment.
Multimodal in-patient treatment incorporating intensive cognitive-behaviour therapy (CBT) and medication management is a promising alternative for obsessive-compulsive disorder (OCD) patients who do not respond to standard out-patient treatment. We prospectively examined the short-term outcome and predictors of outcome of intensive in-patient treatment in a largely pharmacotherapy-resistant OCD sample. Fifty eight consecutive patients, admitted for treatment of OCD were evaluated at admission, at discharge and 2 months post-discharge for psychiatric diagnosis, personality disorders, obsessive beliefs, insight into obsessions and severity of obsessive-compulsive, depressive and anxiety symptoms. All patients received comprehensive treatment consisting of a combination of pharmacotherapy and intensive CBT. The mean Y-BOCS score was 29.38(±5.72) at admission, which reduced to 16.62(±7.91) at discharge and 16.75(±8.85) at follow-up. Thirty five participants (60.3%) met the prespecified criteria for response and 19 (32.8%) for remission. There was a significant reduction in Y-BOCS scores at discharge [43.67 (23.81)%] and post-discharge follow-up [2.18 (29.32)%] as compared to baseline (p<0.01). Baseline Browns Assessment of Beleifs Scale score (insight) was the only variable that statistically differentiated responders and non-responders. In-patient treatment is an effective treatment for medication resistant, severe and chronic OCD. Poor insight is a potential predictor of non-response to in-patient treatment.